Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
DOB?
*
Have you used Retin-A, Renova, or Accutane within the past year? If so, when?
*
I haven't had a facial/peel in the last week, if so when?
*
if your brows are Miroblading/shading/tattooed are they fully healed ? past 6 weeks? if not, when did you get them?
*
Are you using any other skin thinning products and/or drugs that thin the blood?
*
Yes
No
Do you use tanning beds and/or are exposed to the sun on a regular basis?
Yes
No
have you had your brows laminated before?
Yes
No
have you had your brows tinted before?
Yes
No
have you had your brows waxed before?
Yes
No
have you had your lashes lifted before?
Yes
No
I am able to lay down and keep my eyes closed for approx 40-60 min while my technician completed the services
Yes
No
Are you currently taking any medications? If so, please list.
I am informing my technician of any following contraindicated conditions I may have
I am informing my technician should know
Do you have any open skin lesions on the face?
*
Yes
No
Do you have any allergies? If so, please list.
I give DCOR Artistry permission to post on internet/ social medias any before and after photos taken
*
Yes
No
Please note that waxing/perm and tint can have certain side effects such as skin removal, redness, swelling, tenderness, etc.
I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these concerns with DCOR ARTISTRY
I give permission to DCOR ARTISTRY to perform the waxing/perm/tint procedure we have discussed and will hold her harmless from any liability that may result from this treatment.
I agree that if I experience any symptoms I will contact my technician and and consults with a physician at my own expense.
I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing.
I understand that DCOR ARTISTRY will take every precaution to minimize or eliminate negative reactions as much as possible.
I understand that some mild but normal symptoms may occur with brow lamination/wax depending on the sensitivity of my skin during the procedure.
Signature of Client
Submit
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